Provider Demographics
NPI:1821365784
Name:DR DENTAL OF QUINCY PC
Entity Type:Organization
Organization Name:DR DENTAL OF QUINCY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-789-0577
Mailing Address - Street 1:101 FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-8126
Mailing Address - Country:US
Mailing Address - Phone:617-471-4400
Mailing Address - Fax:617-471-4460
Practice Address - Street 1:101 FALLS BLVD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-8126
Practice Address - Country:US
Practice Address - Phone:617-471-4400
Practice Address - Fax:617-471-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty